Medical laser apparatus and system

ABSTRACT

A medical laser apparatus, including: an energy guide; a first energy source configured to generate energy for treating a target tissue through the energy guide; a second energy source configured to emit first and second aiming beams to a target tissue through the energy guide, the second aiming beam having at least one characteristic different from the first aiming beam; and a controller comprising hardware, the controller being configured to: receive a signal indicating an illumination mode from at least two illumination modes used by an endoscope to illuminate the target tissue; and control the second energy source to output the first or second aiming beam based on the indicated illumination mode.

CROSS-REFERENCE TO RELATED APPLICATION

This application claims the benefit of U.S. Provisional Application No.62/628,513 filed on Feb. 9, 2018, the entire contents of which isincorporated herein by reference.

BACKGROUND 1. Field

The invention relates generally to a medical laser apparatus and systemand more particularly to a medical laser apparatus and system for usewith an endoscope system having two or more illumination modes.

2. Prior Art

Medical lasers have been utilized in a variety of treatment proceduresincluding, for example, various endoscopic procedures. Generally, theseprocedures require precisely controlled delivery of energy in order tosuccessfully accomplish the desired procedure.

Generally, a surgical probe is utilized to deliver laser energy to atarget tissue. The surgical probe generally comprises an energy guide,such as an optical fiber, coupled to an energy source, such as a laser,wherein the probe can be positioned such that the tip of the probe ispositioned adjacent to the target tissue. Laser energy is directed outof the tip of the optical fiber onto desired portions of the targettissue. The laser optical fiber coupled to the laser source is requiredto be somewhat flexible such that the optical fiber can be manipulated.The laser system can include, for example, a Thulium Fiber Laser, whichis used to generate the laser light for delivery through the opticalfiber to the target tissue. The laser is capable of being operated indifferent treatment modes, such as a cutting (ablation) mode and acoagulation (hemostasis) mode.

The medical professional performing the particular procedure manipulatesthe optical fiber into position near the targeted tissue and sets thelaser power and mode for various treatments, which may require differentpower and mode settings depending on the treatment, such as vaporizationmode or coagulation mode.

The laser beam used for treating tissue is typically invisible to thehuman eye and to standard image sensors. Therefore, another illuminationsource can be used to generate a visible aiming beam. With the use ofthe aiming beam, an aiming beam spot can appear in the images formedwhen an endoscope is being used to view the target area.

Also, an endoscopic video imaging system has functions to assist theearly detection of minute lesions, such as cancer and preoperativeaccurate diagnosis of diseased areas. The system incorporates specificlight imaging functions using specific light spectra in addition tonormal light imaging. The endoscopic video imaging system can have atleast two illumination modes, white light (normal light) illuminationand a specific light illumination mode. The endoscope also has anillumination mode switching function that changes from the white lightmode to specific light illumination mode or from specific lightillumination mode to the white light mode.

SUMMARY

Accordingly, a medical laser apparatus is provided. The medical laserapparatus comprising: an energy guide; a first energy source configuredto generate energy for treating a target tissue through the energyguide; a second energy source configured to emit first and second aimingbeams to a target tissue through the energy guide, the second aimingbeam having at least one characteristic different from the first aimingbeam; and a controller comprising hardware, the controller beingconfigured to: receive a signal indicating an illumination mode from atleast two illumination modes used by an endoscope to illuminate thetarget tissue; and control the second energy source to output the firstor second aiming beam based on the indicated illumination mode.

Wherein when a white light illumination mode is indicated, thecontroller can control the second energy source to emit the first aimingbeam having a wavelength in the range of 500 nm to 550 nm.

Wherein when a special light illumination mode is indicated, thecontroller can control the second energy source to emit the first aimingbeam having a wavelength in the range of 635 nm to 690 nm. The speciallight mode can be one of a narrow band imaging mode, an autofluorescence imaging mode or an infrared imaging mode.

The controller can be further configured to receive a signal indicatingwhether a spot caused by the first or second aiming beam can beidentified in an image from the endoscope. When the spot cannot beidentified in the image, the controller can be further configured toswitch one of the first or second aiming beams to an other of the firstor second aiming beams. The controller can be further configured toreceive a signal indicating whether a spot caused by the other of thefirst or second aiming beam can be identified in the image from theendoscope. When the spot from the other of the first or second aimingbeam cannot be identified in the image, the controller can be configuredto control the first energy source to prohibit the first energy sourcefrom generating energy for treating the target tissue.

The at least one characteristic can be selected from a group consistingof wavelength, power level and emitting pattern.

The energy guide can be a laser fiber.

The first energy source can be a treatment laser beam.

Also provided is an endoscope controller comprising hardware, where theendoscope controller is for use with an endoscope. The endoscopecontroller being configured to: output a first signal indicating anillumination mode of the endoscope; detect whether a spot from an aimingbeam generated by an aiming beam energy source is visible in an imagecaptured by an image sensor in the endoscope; and outputting a secondsignal based on the detection.

The second signal can be output only where the spot cannot be detectedin the image.

The aiming beam can be a first aiming beam; and where the spot cannot bedetected in the image, the second signal can instruct a laser apparatusto one of change the first aiming beam to a second aiming beam having atleast one characteristic different from the first aiming beam.

Still further provided is a medical system comprising: a medical laserapparatus, comprising: an energy guide; a first energy source configuredto generate energy for treating a target tissue through the energyguide; a second energy source configured to emit first and second aimingbeams to a target tissue through the energy guide, the second aimingbeam having at least one characteristic different from the first aimingbeam; and a first controller comprising hardware, the first controllerbeing configured to: receive a first signal indicating an illuminationmode from at least two illumination modes used by an endoscope toilluminate the target tissue; control the second energy source to outputthe first or second aiming beam based on the indicated illuminationmode; and a second controller comprising hardware, the second controllerbeing for use with an endoscope, the second controller being configuredto: output the first signal to the first controller indicating theillumination mode from the at least two illumination modes used by theendoscope.

When a white light illumination mode is indicated, the first controllercan control the second energy source to emit the first aiming beamhaving a wavelength in the range of 500 nm to 550 nm.

When a special light illumination mode is indicated, the firstcontroller can control the second energy source to emit the first aimingbeam having a wavelength in the range of 635 nm to 690 nm. The speciallight mode can be one of a narrow band imaging mode, an autofluorescence imaging mode or an infrared imaging mode.

The second controller can be further configured to: output a secondsignal indicating whether a spot caused by the first or second aimingbeam can be identified in an image from the endoscope; and the firstcontroller can be further configured to: receive the second signal; andwhen the spot cannot be identified in the image, switch one of the firstor second aiming beams to an other of the first or second aiming beams.

The second controller can be further configured to: output a secondsignal indicating whether a spot caused by the first or second aimingbeam can be identified in an image from the endoscope; and the firstcontroller can be further configured to: receive the second signal; andwhen the spot from the other of the first or second aiming beam cannotbe identified in the image, control the first energy source to prohibitthe first energy source from generating energy for treating the targettissue.

The at least one characteristic can be selected from a group consistingof wavelength, power level and emitting pattern.

The energy guide can be a laser fiber.

The first energy source can be a treatment laser beam.

BRIEF DESCRIPTION OF THE DRAWINGS

These and other features, aspects, and advantages of the presentinvention will become better understood when the following detaileddescription is read with reference to the accompanying drawings in whichlike characters represent like parts throughout the drawings, wherein:

FIG. 1 illustrates a medical system having an endoscope, laserapparatus, endoscope processor and endoscope light source.

FIG. 2 illustrates a schematic view of the medical system of FIG. 1including a distal-end of the endoscope of FIG. 1.

FIG. 3 illustrates a flow chart of a first method of operation of themedical system of FIG. 1.

FIG. 4 illustrates a flow chart of a second method of operation of themedical system of FIG. 1.

DETAILED DESCRIPTION

Referring now to FIG. 1, the same illustrates an overall configurationof a medical system 100 having an endoscope 102, an endoscope processor103, a light source 104, a laser apparatus 106 and a display 108. Asillustrated in FIG. 1, the endoscope 102 includes an insertion section110 configured to be inserted into a subject that images the inside ofthe subject and generates an image signal of the inside of the subject,the endoscope processor 103 that performs predetermined image processingon the image signal captured by the endoscope 102 and controls at leastparts of medical system 100, the light source 104 that generatesillumination light of the endoscope 102 having at least two illuminationmodes, the laser apparatus 106 having a first energy source forgenerating energy for treating a target tissue through an energy guide112 and a second energy source configured to emit two or more aimingbeams to a target tissue through the energy guide 112, and the displaydevice 108 that displays the aiming beam and an image of the imagesignal having been subject to the image processing performed by theendoscope processor 103.

The endoscope 102 includes the insertion portion 110 to be inserted intothe subject, an operating unit 107 to be held by an operator, which ison a proximal end portion side of the insertion portion 110, and aflexible universal cord 114 extended from the operating unit 107.Although FIG. 1 illustrates a Gastrointestinal (GI) endoscope, theapparatus and systems disclosed herein are not limited to a GI endoscopeand also have particular utility for use with other types of endoscopes,such as ureteroscope or cystoscope or those used for a other treatmentprocedures.

The insertion portion 110 is formed using a lighting fiber (lightguide), an electric cable, an optical fiber, and the like. The insertionportion 110 includes a distal end portion 110 a incorporating an imagingunit to be described later, a bendable bend portion 110 b including aplurality of bend pieces, and a flexible tube portion 110 c provided ona proximal end portion side of the bend portion 110 b, which isflexible. The distal end portion 110 a is provided with an illuminationlight guide 120 (see FIG. 2) that illuminates the inside of the subjectvia an illumination lens 122 (see FIG. 2), an observation unit,including an image sensor, such as a CCD or CMOS and an objective lenssystem 118 (see FIG. 2) that images the inside of the subject, aninsertion port 107 b that communicates with a treatment tool channel 102a (see FIG. 2), and an air/water supply nozzle (not illustrated).

The operating unit 107 includes a bending knob 107 a for bending thebend portion 110 b in the up and down direction and the right and leftdirection, the treatment tool insertion port 107 b through which atreatment tool, such as medical forceps or the energy guide 112 isinserted into a body cavity of the subject, and a plurality of switches107 c for operating a peripheral device such as the endoscope processor103, the light source device 104, an air supply device, a water supplydevice, and a gas supply device. The treatment tool, such as the energyguide 112 can be inserted from the treatment tool insertion port 107 band through the channel 102 a such that a distal end thereof is exposedfrom an opening 102 b (see FIG. 2) of the channel 102 a at the distalend of the insertion portion 110.

The universal cord 114 includes a lighting fiber, a cable, and the like.The universal cord 114 is branched at the proximal end thereof. One endof the branched ends is a connector 114 a, and the other proximal end ofthe branched ends is a connector 114 b. The connector 114 a isattachable/detachable to/from a connector of the endoscope processor103. The connector 114 b is attachable/detachable to/from the lightsource 104. The universal cord 114 propagates the illumination lightemitted from the light source 104 to the distal end portion 110 a viathe connector 114 b and the light guide 120 (see FIG. 2). Further, theuniversal cord 114 transmits an image signal captured by the imagesensor 116 (see FIG. 2) to be described later to the endoscope processor103 via a signal line 124 (see FIG. 2) in the cable and via theconnector 114 a.

The endoscope processor 103 executes predetermined image processing onthe image signal output from the connector 114 a, and controls at leastpart of the components making up the medical system 100.

The light source 104 includes one or more light sources that emit lighthaving one or more illumination characteristics, referred to asillumination modes, a condenser lens, and the like. Such light sourcescan be, for example, a Xenon lamp, an LED (Light-Emitting Diode), an LD(Laser Diode), or any combination thereof. Under the control of theendoscope processor 103, the light source 104 emits light from the oneor more light sources thereof, and supplies the light to the endoscope102 connected via the connector 114 b and the light guide of theuniversal cord 114 as illumination light for the inside of the subjectas an object. The illumination modes can be a white light illuminationmode or a special light illumination mode, such as a narrow band imagingmode, an auto fluorescence imaging mode or an infrared imaging mode. Aspecial light illumination can concentrate and intensify specificwavelengths of light, for example, resulting in a better visualizationof a superficial micro-vessel and mucosal surface structures to enhancethe subtle contrast of the irregularities of the mucosa.

The display 108 includes, for example, a liquid crystal display, anorganic electro luminescence (EL) display, or the like. The display 108displays various kinds of information including the image having beensubject to predetermined image processing by the information processingapparatus 103 via a video cable 108 a. This allows an operator toobserve and determine behavior of the desired position inside thesubject by operating the endoscope 102 while watching the image (in-vivoimage) displayed by the display 108.

Referring now to FIG. 2, the medical system 100 of FIG. 1 is shownschematically. The laser apparatus 106 is for use with the energy guide112, such as a laser fiber. The energy guide is disposed in the channel102 a through the treatment insertion port 107 b and includes a distalend 112 a that extends distally from the distal end opening 102 b of thechannel 102 a so as to be configured to direct treatment energy to thetarget tissue. A proximal end of the energy guide 112 is operativelyconnected to the laser apparatus 106.

The laser apparatus 106 includes two or more energy sources forgenerating laser energy coupled to the proximal end of the energy guide112. Such energy sources can be selectable by a user by an input, suchas a button 106 a on the laser apparatus 106 or a foot switch (notshown), through software or a user interface on the display 108 or otherinputs, manual or automatic as are known in the art. A first energysource 202 is optically coupled to the energy guide 112 and can beconfigured to generate energy for treating the target tissue through theenergy guide 112. For example, the first energy source 202 can be athulium laser, used to generate laser light for delivery through thelight guide 112 to the target tissue to operate in different treatmentmodes, such as a cutting (ablation) mode and a coagulation (hemostasis)mode. Other energy sources known in the art for such treatment oftissue, or any other treatment modes, can also be used for the firstenergy source 202, such as Ho:YAG, Nd:YAG and CO₂ as well as othersknown in the art.

The two or more energy sources can also include a second energy source204 also optically coupled to the energy guide 112 and configured toemit at least two aiming beams to the target tissue through the energyguide 112, where the first aiming beam has at least one characteristicdifferent from the second aiming beam. Such differing characteristicscan be wavelength, power level and/or emitting pattern. For example, thefirst aiming beam can have a wavelength in the range of 500 nm to 550 nmwhile the second aiming beam can have a wavelength in the range of 635nm to 690 nm. The characteristics of the different aiming beams can beselected based on the visibility of the aiming beams in the imageprocessed by the endoscope processor 103 and displayed on the display108 under certain illumination modes provided by the light source 104.

The laser apparatus 106 further includes a controller 206 comprisinghardware, such as a CPU, that controls the operation of the laserapparatus 106 including the first and second energy sources 202, 204.The laser apparatus 106 can further include a sensor 208 operativelycoupled to the energy guide 112 and under the control of the controller206. The sensor 208 is configured, as known in the art, to detectreflected light through the energy guide 112 from the distal end 112 aof the energy guide 112 and back to the sensor 208 such that the sensor208 can determine an illumination mode output to the light guide 120from the light source 104. That is, such sensor 208 detects theillumination mode being used to illuminate the target tissue. Suchreflected light detection can be similar to that described in U.S. Pat.No. 5,860,972 issued on Jan. 19, 1999, the contents of which isincorporated herein by reference.

The light source 104 includes one or more light sources, such as a firstlight source 210 and a second light source 212 under the control of acontroller 214. The light sources 210, 212 can be selected by a userthrough an input, such as a button 104 a on the light source 104 or afoot switch (not shown), through software or a user interface on thedisplay 108 or other inputs, manual or automatic as are known in theart. The first and second light sources 210, 212 are optically coupledto the light guide 120 to provide different illumination modes, asdescribed above, to the light guide 120. Although a different lightsource is shown for each illumination mode, a single light source can beprovided to produce illumination modes having different characteristicsthrough the use of filters, lens and the like.

The endoscope processor 103 also includes a controller 216 comprisinghardware, such as a CPU, for control of the endoscope 102, display 108,light source 104 and/or laser apparatus 106. The controller 216, asdiscussed above, receives a signal from the image sensor 116 throughline 124 in the universal cord 114 to process the same so as to generatean image/video for viewing on the display 108. Such image includes notonly the target area of the tissue to be treated under the illuminationof the light source 104 but also an aiming beam generated by the laserapparatus 106 when the first energy source 202 is active and the energyguide 112 is being used to treat the target tissue. The endoscopeprocessor 103 includes one or more inputs, such as a button 103 a on theendoscope processor 103 or a foot switch (not shown), through softwareor a user interface on the display 108 or other inputs, manual orautomatic as are known in the art.

A use of the medical system 100 of FIG. 1 will now be described withregard to the flow chart illustrated in FIG. 3. After insertion of theendoscope 102 to the target tissue site, the user views the targettissue on the display 108 at 300. Such viewing of the target tissue iswith an illumination mode set at 302 and output by one of the lightsources 210, 212 of the light source 104. Such illumination mode can beset by selection by the user by any means known in the art orautomatically provided by a determination made by either of controllers214, 216 based on predetermined criteria.

A determination is made at 304 by the controller 206 as to whether thefirst energy source 202 is activated (on) and delivering treatmentenergy to the energy guide 112. Where it is determined that the firstenergy source 202 is not delivering treatment energy to the energy guide112, the controller 206, at 304N, does not activate the second energysource 204 to generate an aiming beam. Where it is determined that thefirst energy source 202 is delivering treatment energy to the energyguide 112, the controller 206, at 304Y, activates the second energysource 204, at 306, to generate one of the first or second aiming beams.

At 308, the controller 206 determines the illumination mode from theillumination modes used by the endoscope to illuminate the targettissue, such as receiving a signal indicating the type of illuminationmode being used. The illumination mode signal provided to the controller206 can be a manual input from the user at input 104 a of the lightsource 104 to direct the light source controller 214 to output a signalto the controller 216 of the endoscope processor 103, which in turnoutputs a signal to the laser apparatus controller 206. Such manualinput can also be from the input, such as button 103 a, of the endoscopeprocessor 103. The light source controller 214 can also directly outputa signal indicating the illumination mode to the laser apparatuscontroller 206. The input can also be via a button 107 c on theendoscope through signal line 107 d to the controller 216 of theendoscope processor 103, which is in turn relayed to the controller 206of the laser apparatus. The controller 206 of the laser apparatus 106can also receive a signal indicative of the illumination mode used bythe endoscope from the sensor 208, which detects the illumination beingused by reflected light through the energy guide 112 and the controller206 processes such detection and determines the illumination mode basedon the output from the sensor 208. Furthermore, the controller 216 ofthe endoscope processor 103 can analyze the image signal from the imagesensor 116 and determine an illumination mode based on such image signaland output such determination to the controller 206 of the laserapparatus 106. Other sensors (not shown) may also be employed fordetermination of the illumination mode being used by the endoscope, suchas at the distal end of the endoscope 102 or in the endoscope processor103.

At 310, a determination is made as to whether the aiming beam isappropriate for the determined illumination mode. Such determination canbe based on historical data reflected in a look up table (LUT)operatively connected to the controller 206, where the LUT correspondsillumination mode to aiming beam characteristic. Such LUT can store dataof illumination modes (or the wavelength of the illumination light) anda corresponding wavelength of aiming beam for use with such illuminationmode or wavelength of such illumination mode. Where it is determinedthat the aiming beam being used is appropriate for use with theillumination mode being used, no change is required in the aiming beambeing used and the process continues at 310Y to image the target tissueuntil the determination is made at 310N that the aiming beam being usedis not appropriate for use with the illumination mode being used. Suchdetermination can be made upon predetermined intervals or upon anoccurrence of a predetermined event, such as the first energy sourcebeing turned off and then again on.

However, where it is determined, at 310N, that the aiming beam beingused is not appropriate for use with the illumination mode being used,the second energy source 204 is controlled to change the aiming beam at312 based on the indicated illumination mode. For example, when a whitelight illumination mode is determined, the controller 206 can controlthe second energy source 204 to emit a first aiming beam having awavelength in the range of 500 nm to 550 nm. Alternatively, where aspecial light illumination mode is determined, the controller 206 cancontrol the second energy source 204 to emit the second aiming beamhaving a wavelength in the range of 635 nm to 690 nm. As discussedabove, the special light mode can be, for example, one of a narrow bandimaging mode, an auto fluorescence imaging mode or an infrared imagingmode.

Another use of the medical system 100 of FIG. 1 will now be describedwith regard to the flow chart illustrated in FIG. 4, in which 300, 302,304 and 306 are substantially as described above. Where one of theaiming beams, such as the first or second aiming beams is activated bythe laser apparatus 106, a determination is made at 314 as to whether aspot caused by the first or second aiming beam can be identified in animage from the endoscope 102. That is, the controller 216 analyzes theimage signal from the image sensor 116 to determine if the aiming beamspot being used is visible in the image of the target tissue. Suchdetermination of a spot in image data is well known in the art, such asby pixel comparison to determine a disparity (a discontinuity) in pixeldata in an area of the image corresponding to an expected size and/orshape of the spot. Furthermore, such determination may consider the spotto not be visible if a spot is detected but the disparity is below somepredetermined threshold where a user would have trouble identifying thespot clearly from the image.

Where the spot is detected, or is sufficiently detected in the image,the imaging, illumination and display of the image and spot continues,at 314Y, until such determination changes or the laser apparatus nolonger activates the first energy source 202. Where the spot cannot bedetected or not sufficiently detected in the image at 314N, thecontroller 216 outputs a signal, at 316, to the laser apparatuscontroller 206 to switch to a different one of the first or secondaiming beams.

A similar determination is made by the controller 216 at 318 todetermine whether a spot caused by the different one of the first orsecond aiming beams can be identified in the image from the endoscope102. Where the spot is detected, or is sufficiently detected in theimage at 318Y, the imaging, illumination and display of the image andspot continues until such determination changes or the laser apparatusno longer activates the first energy source 202. Where the spot cannotbe detected or not sufficiently detected in the image at 318N, as asafety measure, the controller can output a signal to the laserapparatus controller 206 to control the first energy source to prohibitthe first energy source from generating energy for treating the targettissue at 320.

Although described with regard to a flexible endoscope, the aboveapparatus and methods also have utility for rigid type endoscopes. Inaddition, although the laser apparatus 106 is described as a separatedevice, the features thereof can be incorporated into one or both of thelight source and endoscope processor, in which a common controller canbe used to make the determinations and control indicated herein.

While there has been shown and described what is considered to bepreferred embodiments, it will, of course, be understood that variousmodifications and changes in form or detail could readily be madewithout departing from the spirit of the invention. It is thereforeintended that the invention be not limited to the exact forms describedand illustrated, but should be constructed to cover all modificationsthat may fall within the scope of the appended claims.

What is claimed is:
 1. A medical laser apparatus, comprising: an energyguide; a first energy source configured to generate energy for treatinga target tissue through the energy guide; a second energy sourceconfigured to emit first and second aiming beams to a target tissuethrough the energy guide, the second aiming beam having at least onecharacteristic different from the first aiming beam; and a controllercomprising hardware, the controller being configured to: receive asignal indicating an illumination mode from at least two illuminationmodes used by an endoscope to illuminate the target tissue; and controlthe second energy source to output the first or second aiming beam basedon the indicated illumination mode.
 2. The medical laser apparatusaccording to claim 1, wherein when a white light illumination mode isindicated, the controller controls the second energy source to emit thefirst aiming beam having a wavelength in the range of 500 nm to 550 nm.3. The medical laser apparatus according to claim 1, wherein when aspecial light illumination mode is indicated, the controller controlsthe second energy source to emit the second aiming beam having awavelength in the range of 635 nm to 690 nm.
 4. The medical laserapparatus according to claim 3, wherein the special light mode is one ofa narrow band imaging mode, an auto fluorescence imaging mode or aninfrared imaging mode.
 5. The medical laser apparatus according to claim1, wherein the controller is further configured to receive a signalindicating whether a spot caused by the first or second aiming beam canbe identified in an image from the endoscope.
 6. The medical laserapparatus according to claim 5, wherein, when the spot cannot beidentified in the image, the controller being further configured toswitch one of the first or second aiming beams to an other of the firstor second aiming beams.
 7. The medical laser apparatus according toclaim 6, wherein the controller is further configured to receive asignal indicating whether a spot caused by the other of the first orsecond aiming beam can be, identified in the image from the endoscope.8. The medical laser apparatus according to claim 7, wherein, when thespot from the other of the first or second aiming beam cannot beidentified in the image, the controller is configured to control thefirst energy source to prohibit the first energy source from generatingenergy for treating the target tissue.
 9. The medical laser apparatusaccording to claim 1, wherein the at least one characteristic isselected from a group consisting of wavelength, power level and emittingpattern.
 10. The medical laser apparatus according to claim 1, whereinthe energy guide is a laser fiber.
 11. The medical laser apparatusaccording to claim 1, wherein the first energy source is a treatmentlaser beam.
 12. An endoscope controller comprising hardware, theendoscope controller being for use with an endoscope, the endoscopecontroller being configured to: output a first signal indicating anillumination mode of the endoscope; detect whether a spot from an aimingbeam generated by an aiming beam energy source is visible in an imagecaptured by an image sensor in the endoscope; and outputting a secondsignal based on the detection.
 13. The endoscope controller of claim 12,wherein the second signal is output only where the spot cannot bedetected in the image.
 14. The endoscope controller of claim 12,wherein: the aiming beam is a first aiming beam; and where the spotcannot be detected in the image, the second signal instructs a laserapparatus to one of change the first aiming beam to a second aiming beamhaving at least one characteristic different from the first aiming beam.15. A medical system comprising: a medical laser apparatus, comprising:an energy guide; a first energy source configured to generate energy fortreating a target tissue through the energy guide; a second energysource configured to emit first and second aiming beams to a targettissue through the energy guide, the second aiming beam having at leastone characteristic different from the first aiming beam; and a firstcontroller comprising hardware, the first controller being configuredto: receive a first signal indicating an illumination mode from at leasttwo illumination modes used by an endoscope to illuminate the targettissue; control the second energy source to output the first or secondaiming beam based on the indicated illumination mode; and a secondcontroller comprising hardware, the second controller being for use withan endoscope, the second controller being configured to: output thefirst signal to the first Controller indicating the illumination modefrom the at least two illumination modes used by the endoscope.
 16. Themedical system of claim 15, wherein when a white light illumination modeis indicated, the first controller controls the second energy source toemit the first aiming beam having a wavelength in the range of 500 nm to550 nm.
 17. The medical system according to claim 15, wherein when aspecial light illumination mode is indicated, the first controllercontrols the second energy source to emit the first aiming beam having awavelength in the range of 635 nm to 690 nm.
 18. The medical systemaccording to claim 17, wherein the special light mode is one of a narrowband imaging mode, an auto fluorescence imaging mode or an infraredimaging mode.
 19. The medical system according to claim 15, wherein: thesecond controller is further configured to: output a second signalindicating whether a spot caused by the first or second aiming beam canbe identified in an image from the endoscope; and the first controlleris further configured to: receive the second signal; and when the spotcannot be identified in the image, switch one of the first or secondaiming beams to an other of the first or second aiming beams.
 20. Themedical system according to claim 15, wherein: the second controller isfurther configured to: output a second signal indicating whether a spotcaused by the first or second aiming beam can be identified in an imagefrom the endoscope; and the first controller is further configured to:receive the second signal; and when the spot from the other of the firstor second aiming beam cannot be identified in the image, control thefirst energy source to prohibit the first energy source from generatingenergy for treating the target tissue.
 21. The medical system accordingto claim 15, wherein the at least one characteristic is selected from agroup consisting of wavelength, power level and emitting pattern. 22.The medical system according to claim 15, wherein the energy guide is alaser fiber.
 23. The medical system according to claim 15, wherein thefirst energy source is a treatment laser beam.